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By
Barbara Tone,
RN Nurses are dealing with pressure to join unions like never before. Some say unions are a powerful way to make sure nurses’ concerns are addressed and to improve patient care. But others think increased union membership deals a blow to nurses’ standing in health care without solving the real problems. The trend toward unionization has extended from grassroots local groups to the American Nurses Association (ANA), which recently voted to create an entity to assist state nursing associations with collective bargaining. “Our calls requesting assistance in the collective bargaining process have about doubled in the last two to three years,” said Anna Gilmore-Hall, RN, director of labor relations and workplace advocacy at the ANA. The California Nurses Association (CNA), the state’s largest collective bargaining agent for registered nurses, has also experienced a dramatic increase in calls for information about unionizing. “Last year, we received over 200 requests for information,” said Beth Kean, director of organizing. Since 1991, the CNA has added nearly 6,000 RNs at 20 facilities to its ranks, and has an additional 3,000 at seven hospitals that will soon vote on whether to unionize. The Service Employees International Union (SEIU), the second largest RN representative in the state, also reports an increase in calls. Why join, why now? Nurses say they are being driven to collective bargaining by dramatic shifts in their working conditions and the lack of response to their concerns. “We are being asked to do more and more with less and less,” said Cindy Barrett, RN, a nurse at Northridge Hospital Medical Center who is working for union representation there through the SEIU. “At this point there’s hardly a nurse here who isn’t for the union. Three years ago there were quite a few who thought we could negotiate and get changes through dialogue with administration, but things just kept getting worse and worse.” Northridge officials say they try to be responsive to nurses’ concerns. “We try to look really hard at where resource allocation needs to be and work to get the highest level of care with the resources we have,” said Roger Seaver, president of Northridge Hospital Medical Center. “I would love to stay a non-union workforce because I think it gives the staff more direct input into the decision-making process, but I certainly respect and support the right of individuals to make choices.” The CNA’s Kean said the desire to unionize does not develop overnight. “It’s never a period of months; it’s years of nurses not being listened to.” A question of priorities Many nursing experts agree that the shift to unionization is a predictable outcome of years of bad management practices. “We have probably fractured every single management principle ever laid down,” said Leah Curtin, RN, FAAN, publisher of Curtin Calls, a healthcare newsletter, and former editor of Nursing Management. “The problem is that nurses have been bloodied,” Curtin said. “When you treat people like interchangeable parts and renege on agreements, you will get a union—and you deserve one. Nurses are ripe for unions, and they want some tough guys because they have been jerked around very badly.” Some say the intense focus on budget matters has tipped management away from clinical issues. “I think that the crux of the problem is that clinical priority and decision making have been lost,” said Linda Aiken, PhD, RN, Claire M. Fagan Leadership professor of nursing and sociology at the University of Pennsylvania in Philadelphia. “Traditionally, there were two lines of authority—clinical and management. I would argue that, over time, the clinical has been so demoted that we now have a singular authority structure represented by management.” Many nurses say that loss of clinical control is visible in their daily work. Union officials report hearing horror stories from nurses about their work in the trenches. “Nurses see the day-to-day effect of the corporatization of health care,” said Kean. “The stuff out there is nightmarish.” Who speaks for you? The pro-union sentiment is not universal. As might be expected, much of the opposition comes from management, but not all staff nurses feel that collective bargaining adequately represents their interests. “I’m not against the union,” said Vicki Childress Wilson, RN, a nurse at UCLA Medical Center. “I take each issue on an individual basis, but overall, I often don’t feel that they represent me as a college-educated professional. I’ve been a nurse for 23 years and have been among those abused and downtrodden. I’ve seen changes in how the university treats the nurses, but I think it’s because they think we’re a pain in the neck, not because of any increased respect for us. [With the union] it always seems like an issue of money, and that’s just not where my concerns are at this point in my career. Paying me more doesn’t make me happier about the patient care issues.” But union advocates say patient care is their central concern. “We have a single focus. We believe that the RN has an irreplaceable role in providing care,” Kean said. “The major complaints we get are about staffing and respect for nurses.” Watching the budget For their part, nurse executives have the difficult task of trying to balance the financial realities of the industry with the very real needs of the nurses on the front line. Finding the middle ground where nurses feel valued, budget constraints are met, and patients get the care they deserve is a dilemma all chief nursing officers share. “I absolutely support the right of nurses to be represented,” said Pat Davis, chief nursing officer at Good Samaritan Hospital in San Jose, whose nurses are represented by the CNA. “But my biggest fear is that nurses may not be as involved as they need to be in understanding the issues. You have to stay informed to make informed decisions.” Just as nurses sometimes feel executives don’t focus enough on clinical issues, managers often say unions’ real interests are mostly about money. “The frustration on the management side comes if there is only talk of hours and dollars,” said Marilyn Chow, DNSc, RN, FAAN, vice president for patient care services at Summit Medical Center in Oakland, where RNs are represented by the CNA, and dean for clinical affairs at Oakland’s Samuel Merritt College. “We would really like for the nurses to also come and say, ‘Here’s a problem on the unit; if we do this intervention or this study, we can improve it.’ We all have to be doing our best and that’s hard these days. It takes a lot on both sides.” Restrictive contracts Management experts also express concern about restrictions that may accompany union contracts. Susan Harris, MPA, RN, senior vice president of Pacific Health Consulting, sees obstructions to speedy problem solving. “There is a real danger of the labor contracts becoming so restrictive that every change has to be negotiated,” she said. “That could seriously retard our ability to make the changes necessary to deal with the future.” Others see unions as a vital part of the changes that need to be made. “As independent employees, nurses don’t have any power,”Kean said. “ The only way to act as a professional is to have professional power and exert some authority in your environment. It needs to be the professionals in the facility supporting each other around patient care”. Others see obstructions on a more personal level. “Having worked in both union and non-union environments, and in both labor and management, I see restraints on what can be done to accommodate individuals in the union setting,” said Gwen Brownfield, MSc, RN, vice president of patient care services at Glendale Adventist Medical Center, where the nurses are not unionized. “If someone has a problem and asks for help to work it out, you have to check the contract and do only what it allows. Without that obstacle, you can look at individual needs and see what works best for that person.” Some think unionized nurses are simply trading one type of control for another. “When nurses decide to hand over their industry to union officials, they are simply jumping from the frying pan into the fire,” said Stefan Gleason, vice president of the National Right to Work Foundation, a Virginia-based group opposed to mandatory union membership. On the other hand, “we have to look at the reality of things, especially in health care,” Kean said, and many think nurse unions are the best way to amplify nurses’ voices. With the continuing upheaval in health care, the move to gain voice and power—with or without collective bargaining—will likely continue for years, and only hindsight will reveal whether unionization is ultimately in the best interests of the profession and its patients.
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